"Patients were not happy they had to make other arrangements," said Tom Kempel, president and owner of Star Ambulance and Assisted Mobility Solutions. "As far as I know they've found other means of transport, but they were not thrilled about losing the service."

The agency, 3155 Business U.S. 20, was facing a four- to nine-month backlog in Medicaid reimbursements from the state. Plus, even when those payments came in, the amount fell short of what it cost to provide patients with a wheelchair transport to dialysis appointments several times each week.

The backlog of bills waiting to be paid by the state comptroller's office has grown by $3 billion since the spring, when Illinois was flush with tax revenue. Officials there predict that the outstanding-bill total will hit $9 billion by the end of the year.

Bob Esmond, who owns Mercy Ambulance in Rockford, was working with Assisted Mobility Solutions in September when the decision was made to eliminate the free dialysis rides.

"They were getting reimbursed $14.35 per ride and the actual cost was closer to $25," he said. "They were losing $3,000 a month providing that assistance."

Over the years, the losses Assisted Mobility Solutions incurred from back payments and reimbursement shortfalls forced cuts in other areas of the business. For example, Kempel said, the company had to cut back on insurance offerings for employees.

Assisted Mobility still provides rides for nursing home and hospital patients, along with private-pay customers, in Stephenson County.

But as far as picking up the slack for the shortfall from the state, Kempel said there's no longer any room for that in the budget.

"We'd had to cut back just about to the bare bones the last year just to continue providing the service. The decision had to be made just to stay in business."